Women's Health Education

What It Is

Abnormal uterine bleeding (AUB) refers to any bleeding that differs from a woman's normal menstrual pattern in timing, frequency, duration, or amount. It includes heavy menstrual bleeding, bleeding between periods, and irregular cycles. The PALM-COEIN classification system (Polyp, Adenomyosis, Leiomyoma, Malignancy — Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not yet classified) is used by physicians to categorize causes.

Common Causes & Evaluation

• Uterine polyps or fibroids (structural)
• Ovulatory dysfunction (hormonal imbalance)
• Endometrial hyperplasia or cancer
• Coagulation disorders (e.g., von Willebrand disease)
• Thyroid dysfunction or hyperprolactinemia
• Evaluation includes pelvic exam, ultrasound, endometrial biopsy when indicated, and lab workup

What They Are

Uterine fibroids are noncancerous growths of the uterine muscle (myometrium). They vary widely in size, number, and location — submucosal (inside the uterine cavity), intramural (within the wall), and subserosal (on the outer surface). Many women have fibroids with no symptoms. When symptomatic, fibroids are a leading cause of heavy menstrual bleeding, pelvic pain, and reproductive challenges.

Management Options

• Medical: hormonal suppression, GnRH agonists, progesterone IUDs
• Minimally invasive: hysteroscopic resection, laparoscopic myomectomy
• Uterine fibroid embolization (UFE)
• Focused ultrasound (MRI-guided)
• Surgical: robotic myomectomy or hysterectomy (definitive)
• Treatment is individualized based on symptoms, size, and fertility goals

What It Means

Cervical dysplasia (cervical intraepithelial neoplasia, or CIN) describes abnormal cell changes on the surface of the cervix. Graded CIN 1, 2, or 3 based on severity. CIN 1 often resolves spontaneously; CIN 2–3 requires surveillance or treatment. The goal of cervical cancer screening (Pap + HPV co-testing) is to detect these changes before they progress. Following ASCCP evidence-based guidelines, management is personalized to risk level.

Screening & Treatment

• Pap smear every 3 years (ages 21–65) or co-testing every 5 years (ages 25–65)
• Colposcopy with biopsy for abnormal results
• LEEP (loop electrosurgical excision procedure) for CIN 2–3
• Cold knife cone biopsy for complex cases
• HPV vaccination (Gardasil 9) — prevention through age 45
• Post-treatment surveillance per ASCCP 2019 guidelines

Screening by Cancer Type

• Cervical: Pap + HPV co-testing per ASCCP guidelines; HPV vaccination
• Uterine/Endometrial: No routine screening; report abnormal bleeding promptly — especially postmenopausal
• Ovarian: No effective general screening; BRCA1/2 testing for high-risk women; TVUS + CA-125 in select cases
• Vaginal & Vulvar: Annual pelvic exam; Pap for DES-exposed women

Risk Reduction Strategies

• HPV vaccination (Gardasil 9) — most effective before sexual debut
• Genetic counseling for BRCA1/2, Lynch syndrome, BRIP1, RAD51
• Risk-reducing salpingo-oophorectomy (RRSO) for BRCA carriers
• Oral contraceptive use reduces ovarian and endometrial cancer risk
• Maintain healthy BMI — obesity is a major risk factor for endometrial cancer
• Avoid tobacco — associated with cervical and vulvar cancer

U.S. Incidence & Mortality

• Uterine cancer: ~67,880 new cases/yr — most common gynecologic cancer; mortality rising
• Ovarian cancer: ~19,680 new cases/yr — highest mortality rate among gynecologic cancers; ~77% diagnosed at late stage
• Cervical cancer: ~13,820 new cases/yr — largely preventable through vaccination and screening
• Vulvar cancer: ~6,740 new cases/yr
• Vaginal cancer: ~1,080 new cases/yr

Disparities & Trends

• Black women have 2× the mortality rate for uterine cancer vs. White women
• Hispanic women have the highest rates of cervical cancer in the U.S.
• Uterine cancer mortality is rising — especially in non-Hispanic Black women
• Ovarian cancer 5-year survival: ~50% overall; ~92% when caught at Stage I
• Cervical cancer is nearly eliminated in countries with high HPV vaccination coverage
• Source: American Cancer Society, SEER Database, SGO 2024